Value Based Healthcare: What is it all about? Effects on Spitex

Translated, this means "value-oriented healthcare". Its core aim is to find an optimal compromise between subjective and objective benefits for all patients. The aim is to guarantee them cost-effective and, above all, high-quality medical care in the long term. Value-based healthcare therefore makes it possible to increase the quality of treatment while at the same time reducing the costs involved.

The number of older people suffering from chronic illnesses is increasing. The number of young, working people, on the other hand, is stagnating or even shrinking. This increases costs and staffing requirements in the healthcare sector enormously. Nevertheless, the focus should always be on the benefits for patients.

New ideas and technological advances in science and research, as well as the experience-based optimization of strategies already in use, are providing a remedy. Service providers find themselves in a comprehensive interplay that improves patients' quality of life.

However, they are under constant pressure to always offer better value for money. They are pressured to always put what is financially viable above what is actually feasible. This requires finding a way to put the price of a service in relation to its benefits.

Objectifying human well-being, health and lifetime and giving them a market value is no easy task. It requires a consensus among all relevant stakeholders and general recognition in society. Michael Porter, among others, has dedicated himself to the task of valuation. In his book "Redefining Health Care", published in 2006, he defined the value of healthcare services.

According to this, they are the result that could be achieved per dollar spent on a service. So it is not the number of treatment steps that make up the patient value, but the result that all these steps achieved.

Health outcomes must always be optimized. According to Porter, it is essential to collect and compare data on "patient value" and treatment outcomes. The Institute for Healthcare Improvement developed an approach to optimizing healthcare services in 2007. It formed the framework for the "Triple Aim for health care". According to this, there should be a simultaneous focus on three dimensions:

• Increase quality of treatment and patient satisfaction
• Improve the general health of the population
• Reduce per capita costs for treatments

What was new about this approach was that it was no longer just the patients' subjective experiences that counted, but two new points were added. The holistic view of population health, for example, had often been ignored until then. Numerous causes of certain diseases can be found in the social context.

How can the subjective state of health of patients be measured without external influence?

In value-based healthcare, the focus is clearly on patients. This makes it all the more important to find ways for them to share their subjective feelings for the outcome measures. These self-reported results are called "Patient Reported Outcomes Measures" - PROMs for short.

Certain tools are used to enable patients to report their state of health before and after treatment. Their answers are not distorted and are therefore not influenced or interpreted by other people such as hospital staff.

Satisfaction across the entire patient pathway, on the other hand, is measured using the PREMs tools. PREM stands for "Patient Reported Experiences Measures". Patients report on their treatment experiences and how they felt they were treated in the healthcare system. They also state how they rate the treatment outcome and how they perceived the behavior of healthcare providers.

Even though PROMs and PREMs are becoming increasingly important, the data collected directly via the healthcare system remains just as important. Among other things, they provide valuable information on what measures were taken during visits to the doctor and during hospital stays. They also communicate how long these lasted and what complications may have occurred.

What impact does value-based healthcare have on Spitex?

Representatives of global healthcare companies also see value-based healthcare as a very effective way forward for the Swiss healthcare system. In the eyes of the experts, Switzerland could even play a pioneering role in this area. The country has always been committed to quality and thus drives innovation.

In addition, the various players are already very well networked and there is a general willingness to develop solutions together. The VBHC concept is particularly convincing because it focuses on the personal benefits for clients. At the same time, the goals remain affordable. VBHC thus promotes trust and supports sustainable innovation.

This also benefits the people who make use of Spitex services. More and more older people require long-term care, which is why the topic of home care is becoming increasingly relevant. And yet knowledge about the quality and use of Spitex care is still not good enough.

What is needed is a relevant source of data that can be used to deepen this knowledge. A new tool from the Zurich University of Applied Sciences ZHAW is taking on this role. The basis of this project was the problem that the surveys on client satisfaction did not always meet scientific quality criteria.

The aim was therefore to create a tool that would make it possible to measure satisfaction and map critical events. This should be able to provide an all-round picture of overall satisfaction with the respective Spitex. The aim was to be able to better assess the client's perspective.

The path to the finished questionnaire

Intensive discussions with experts and telephone interviews with clients took place on the way to the goal. The ZHAW employees tested the results obtained in this way in a pilot project in a public and a private Spitex. The clients filled in an open text field and described their personal experiences with Spitex.

The information was then compared with the questions that the ZHAW had already prepared. In this way, the experts ensured that they were asking the right questions from then on. The result was a scientifically based tool that every Spitex organization can use itself and that enables comparisons with other organizations.

It was a catalog with ten questions. This greatly reduced number is due to its practicality. Time and personnel resources are often limited in the Spitex sector. It would simply not be practicable to evaluate a questionnaire that was too comprehensive.

But to what extent are the collected responses useful to Spitex? They provide feedback from the client's point of view, showing where there is still potential for optimization. It is not uncommon for clients' perceptions to differ significantly from those of hospital staff. This is precisely what makes this evaluation system so relevant for increasing patient value.

Are you looking for Spitex for your relative? If so, there are numerous organizations to choose from, which makes the decision difficult. We at OPAN® will help you find a Spitex in your area that meets the needs of your relative. Do you have any questions or need advice? Then please contact us!